Objective : An elevated pulmonary vascular resistance (PVR) of more than 2.5 Wood units (WU), unresponsive to pharmacological intervention, is still considered a major contraindication for heart transplantation because of the risk of life-threatening right ventricular failure. We evaluated the effect of a left ventricular assist device (LVAD) on the PVR in heart transplant candidates.
Methods : Out of 21 patients, undergoing a chronic LVAD implantation, 6 had pulmonary hypertension exceeding 2.5 WU (PVR 4.35 ± 1.29, range 5.8-2.9 ) in their pre-transplant analysis.
A nitroglycerine challenge did not succeed to reduce PVR to acceptable levels (< 2.5 WU).
These six patients received a Novacor LVAD for decompensation of end-stage chronic cardiac failure (NYHA class IV). Pulmonary artery pressures and cardiac index were continuously monitored during the first week after LVAD implantation. PVR was reassessed one week after heart transplantation.
Results : One patient required a right ventricular support system (4 days). Cardiac index and pulmonary artery pressures returned to normal in the early postoperative phase (48 hours).
All patients survived the LVAD implantation and 5 patients could be discharged from hospital.
After a mean support time of 138 ± 89 days, PVR had fallen significantly (p=0.001) to 2.12 ± 0.4 (range 2.6-1.6) WU. All patients are transplanted and still alive after a mean follow-up of 19.1 ± 15.3 months.
Conclusion : In patients with pulmonary hypertension and end-stage chronic cardiac failure, a powerful LVAD is able to restore normal cardiac index within the first days after implantation. Adequate reduction of PVR allows safe subsequent heart transplantation.